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Decision Making and the Child with Afebrile Seizures

To make appropriate decisions about afebrile seizures and about epilepsy, the pediatrician must understand their natural history and the effects of treatment. The decision-making process is slightly more complicated for afebrile seizures than for febrile seizures because there are several types of seizures with different etiologies, and there may be different natural histories for each child and for each seizure type.

Neonatal Seizures

Neonatal seizures are defined as seizures that occur during the first 28 days of life (principally during the first few days), but that do not indicate epilepsy. Neonatal seizures are usually acute, symptomatic, and most frequently due to lack of oxygen, trauma, bleeding, infarction, infection, brain maldevelopment, and occasionally to metabolic problems.

Seizures in the newborn require immediate evaluation. The need for and benefits of anticonvulsant treatment and even the significance of the seizures are topics of current debate. Neonatal seizures have virtually no relationship to later epilepsy unless the child has suffered sufficient damage to the brain to manifest evidence of cerebral palsy later. Although neonatal seizures are the best predictor of future neurologic damage, most infants with these seizures do well, and there is little evidence that the seizures damage the newborn cortex.

Seizures and Epilepsy

DEFINITION

A seizure is defined as a paroxysmal electrical discharge of neurons in the brain resulting in alteration of function or behavior.

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				D. L. Gilbert and C. R. Buncher An EEG should not be obtained routinely after first unprovoked seizure in childhood Neurology, February 8, 2000; 54(3): 635 - 635. [Abstract] [Full Text] [PDF]

				E. P.G. Vining Gaining a Perspective on Childhood Seizures N. Engl. J. Med., June 25, 1998; 338(26): 1916 - 1918. [Full Text]